Department of Radiology, Fukuchiyama City Hospital, 231 Atsunakamachi, Fukuchiyama, Kyoto Prefecture, 620-8505, Japan.
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Sci Rep. 2018 Jul 12;8(1):10538. doi: 10.1038/s41598-018-28730-1.
To compare the outcome of low-dose rate brachytherapy (LDR-BT) and image-guided intensity-modulated radiotherapy (IG-IMRT) for localized prostate cancer, we examined 488 LDR-BT and 269 IG-IMRT patients. IG-IMRT treated older and advanced disease with more hormonal therapy than LDR-BT, which excluded T3b-T4 tumor and initial PSA > 50 ng/ml. The actuarial five-year biochemical failure-free survival rate was 88.7% and 96.7% (p = 0.0003) in IG-IMRT and LDR-BT, respectively; it was 88.2% (85.1% for IG-IMRT and 94.9% for LDR-BT, p = 0.0578) for the high-risk group, 95.2% (91.6% and 97.0%, p = 0.3361) for the intermediate IG-IMRT and 96.8% (95.7% and 97%, p = 0.8625) for the low-risk group. Inverse probability of treatment weighting (IPTW) involving propensity scores was used to reduce background selection bias. IPTW showed a statistically significant difference between LDR-BT and IG-IMRT in high risk (p = 0.0009) and high risk excluding T3-4/initial PSA > 50 ng/ml group (p = 0.0073). IG-IMRT showed more gastrointestinal toxicity (p = 0.0023) and less genitourinary toxicity (p < 0.0001) than LDR-BT. LDR-BT and IG-IMRT showed equivocal outcome in low- and intermediate-risk groups. For selected high-risk patients, LDR-BT showed more potential to improve PSA control rate than IG-IMRT.
为了比较低剂量率近距离放射治疗（LDR-BT）和图像引导调强放射治疗（IG-IMRT）治疗局限性前列腺癌的疗效，我们检查了 488 例 LDR-BT 和 269 例 IG-IMRT 患者。与 LDR-BT 相比，IG-IMRT 治疗的患者年龄更大、疾病更晚期，且接受了更多的激素治疗，LDR-BT 排除了 T3b-T4 肿瘤和初始 PSA>50ng/ml。IG-IMRT 和 LDR-BT 的五年生化无失败生存率分别为 88.7%和 96.7%（p=0.0003）；高危组为 88.2%（IG-IMRT 为 85.1%，LDR-BT 为 94.9%，p=0.0578）；中危组为 95.2%（IG-IMRT 为 91.6%，LDR-BT 为 97.0%，p=0.3361）；低危组为 96.8%（IG-IMRT 为 95.7%，LDR-BT 为 97%，p=0.8625）。采用倾向评分进行逆概率治疗加权（IPTW）以减少背景选择偏倚。IPTW 显示高危组（p=0.0009）和高危组排除 T3-4/初始 PSA>50ng/ml 组（p=0.0073）中 LDR-BT 和 IG-IMRT 之间存在统计学差异。IG-IMRT 比 LDR-BT 胃肠道毒性更大（p=0.0023），而泌尿生殖毒性更小（p<0.0001）。LDR-BT 和 IG-IMRT 在低危和中危组中的疗效相当。对于选定的高危患者，LDR-BT 显示出比 IG-IMRT 更有潜力提高 PSA 控制率。
